Provider Demographics
NPI:1922179506
Name:JAMIESON, SCOTT A (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1029 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2620
Mailing Address - Country:US
Mailing Address - Phone:906-228-8720
Mailing Address - Fax:906-228-2064
Practice Address - Street 1:1029 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2620
Practice Address - Country:US
Practice Address - Phone:906-228-8720
Practice Address - Fax:906-228-2064
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010102921223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics